Getting the Right Information is Key – Stephanie

Case study: Stephanie

Age: 60

Single (divorced)

Job: Women’s Health Physiotherapist and Off Road Driving Instructor

Summary of case study: Stephanie, who is now menopausal, started to experience symptoms at 46. After experiencing a series of symptoms, Stephanie had been using an unlicensed progesterone cream and had also been given antidepressants.  She had been seen in a rheumatology clinic for investigations into her joint pains which were all normal (related to her hormones).  She also had dry eyes, hair loss, low self-esteem and extreme fatigue.  She described herself as a ‘shadow of her former self’, until she found the right solution which she said was like being in a desert after the rains when all the flowers bloom. 

Stephanie is encouraging women to find out the facts so that they can make informed decisions on what is right for them.  She also knows many experienced teachers, nurses and managers who have reluctantly ‘retired’ due to overwhelming menopause symptoms and says better advice and support is needed for women in the workplace.  

Stephanie’s story:

The perimenopause coincided with a difficult period in my personal life, following the death of a close relative and culminating in my 18-year-old son suffering life changing injuries in a car accident, and the break-up of my marriage. I felt anxious, had difficulty concentrating, experienced overwhelming fatigue and irritability all of which I attributed to stress, however with the onset of hot flushes and approaching 47 I realised it was the Menopause!

At that time the consensus was that HRT is not ‘natural’ and was said to be linked with an increased risk of blood clots and breast cancer, so I decided it wasn’t for me. For years I used a natural Progesterone cream marketed as Bio Identical HRT (extracted from Yam and obtained online from Guernsey), and based meals on Linda Kearns ‘Eat to beat the Menopause’ to increase my consumption of phytoestrogens, I also exercised regularly. At one point I was prescribed anti-depressants which did relieve hot sweats and reduced anxiety, but little else.

Fatigue, ‘brain fog’ and lack of confidence in myself had a big impact. Working part-time as a Musculoskeletal Physiotherapist in busy NHS clinics, tiredness and poor concentration was a huge concern.  I was constantly double checking my notes, and reading articles to ensure I was following best practice, which in itself was tiring. During this time, I was also taking my son to numerous medical and legal appointments in various locations around England, and training as an off road driving instructor (a passion I still enjoyed); I suffered huge anxiety during those appointments and driving assessments. 

By 2016 I was concerned that I may have to give up work due to my joint pains, fatigue and poor concentration. My mother had been on HRT for almost 20 years (from 1983) and her joint pains were significantly reduced so that she was able to carry on working until her 70s. A Rheumatologist had excluded inflammatory arthritis, so I decided to try HRT. I Googled ‘Menopause doctors’ in the West Midlands and found Dr Newson’s contact details for Spire Hospital in Solihull. My first consultation was in January 2017.

I filled in a questionnaire to identify my symptoms, including their severity, and Dr Newson explained the impact reduced oestrogen can have on different systems of the body. She also explained how safe body-identical oestrogen gel and Micronised Progesterone are, and that some older studies on HRT were flawed. She prescribed HRT and I had a blood test to ensure I was taking the correct dose.

I began treatment immediately, and increased my dose of oestrogel as appropriate on receiving the results of my blood test. Within three weeks my symptoms had started to ease; at my follow up consultation with Dr Newson I told her I felt as if I had my old self back. I think the analogy I used was of a desert after the rains when all the flowers bloom.

The only symptoms I have now are difficulty sleeping, fatigue and joint pains during Osteo-arthritic flare ups, which affects my hands, lumbar spine, knees, feet and left hip (the right one was replaced two years ago). Since first meeting Dr Newson I have continued studying and taken on a new role as a Women’s Health Physiotherapist, treating incontinence and prolapse issues and pelvic pain. In this role I meet many women experiencing bladder and vaginal symptoms and see first-hand the benefit of local oestrogen and HRT alongside Pelvic Floor exercises and bladder training. I also continue to work as an off road driving instructor, and feel very privileged to be able to continue working in two jobs I love.

If I could give a message to women facing perimenopausal or menopausal symptoms, it would be don’t struggle on trying to ‘pull yourself together’ or feel it is a personal weakness when you can’t string two thoughts together or forget words. Find out the facts for yourself: there are excellent websites and NICE guidelines based on good quality evidence, then you can make an informed decision on what is right for you.

What’s more, the role of women has significantly changed over the years, we are living and working longer, often with added responsibilities for teen and adult children, grandchildren and elderly relatives. I know of many experienced teachers, nurses and managers who have reluctantly ‘retired’ due to overwhelming menopause symptoms. Fortunately, my NHS Trust employer values the expertise and experience of its female staff and runs Menopause Workshops offering advice and support, which will benefit women and their families, as well as patients.